Pediatric Leptospirosis Treatment & Management

  • Author: Patrick W Hickey, MD, FAAP; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jul 27, 2010
 

Medical Care

Empiric antimicrobial therapy in leptospirosis must be comprehensive and should cover all likely pathogens in the context of the clinical setting. No controlled studies have been performed to evaluate the efficacy of antibiotics for leptospirosis specifically in children, nor have specific doses been used consistently in reported case series. The following dosage guidelines are extrapolated from research on adult patients.

Besides the antibiotics described below, many case series report other antimicrobials that have been used to successfully treat leptospirosis. A randomized, controlled study comparing azithromycin to doxycycline suggested efficacy.[24] Broth microdilution testing has shown sensitivity to macrolides, fluoroquinolones, cephalosporins, and carbapenems.[25]

Antibiotic therapy should be initiated as soon as the diagnosis is considered and should be continued for a full course despite initial serologic results because most patients are diagnosed only through acute and convalescent testing. Early treatment has been shown to offer the best clinical outcomes; results from controlled studies of treatment during the immune phase have yielded mixed results.[26, 27]

According to some reports, patients with leptospiral renal failure, hypothesized to be immune complex mediated, have been successfully treated without dialysis by administering high-dose pulsed steroids (methylprednisolone 30 mg/kg/d, not to exceed 1500 mg). These authors also discuss the role of high-dose pulsed steroids in areas with limited resources where dialysis treatment is unavailable and would involve lengthy medical transport. The use of renal dose dopamine in conjunction with steroids or diuretics has also been described.[13] Pulse-dose steroids may also play a role in the management of severe pulmonary disease.[28, 29] Ophthalmic drops of mydriatics and corticosteroids have been used for relief of ocular symptoms.[30]

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Patrick W Hickey, MD, FAAP  Assistant Professor of Pediatrics and Preventive Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Disease, Walter Reed Army Medical Center

Patrick W Hickey, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Tropical Medicine and Hygiene, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary J Noel, MD  Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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